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Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance
Author(s) -
Maino Paolo,
Presilla Stefano,
Colli Franzone Paola A.,
van Kuijk Sander M.J.,
Perez Roberto S.G.M.,
Koetsier Eva
Publication year - 2018
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12677
Subject(s) - medicine , fluoroscopy , facet joint , interquartile range , retrospective cohort study , nuclear medicine , lumbar , radiology , dose area product , statistical significance , cohort , surgery
Background Transforaminal epidural steroid injections ( TFESI s) and facet joint blocks can be performed under fluoroscopy or computed tomography ( CT ) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESI s and facet joint blocks under CT guidance vs. fluoroscopic guidance. Methods The primary outcome of this retrospective cohort study was the difference between the estimated effective dose ( ED ) of CT guidance and fluoroscopic guidance for TFESI s and facet joint blocks. Patients who had undergone these procedures with both CT and fluoroscopic guidance were eligible for this study. Dose‐length product for CT ‐guided procedures and dose‐area product for fluoroscopic‐guided procedures were retrospectively collected and converted to ED . Within‐ or between‐group comparisons were performed with appropriate nonparametric tests, using a P value of < 0.05 to indicate statistical significance. Results The 42 patients included in this study underwent a total of 100 procedures. The median estimated ED differed significantly between CT ‐guided injections and fluoroscopic‐guided injections (1.59 mSv (interquartile range [ IQR ] 0.78 to 3.09) vs. 0.19 mSv ( IQR 0.11 to 0.30) (Wilcoxon signed rank test, P < 0.001). Conclusions The study results suggest that TFESI s and facet joint blocks performed with CT guidance are associated with more than 8 times higher patient radiation dose exposure compared to fluoroscopic guidance. There needs to be more vigilance with regards to CT guidance in interventional pain procedures.